Search

Mrs Lee, a 56-year-old homemaker, visited your clinic requesting for a Pap smear. Her last Pap smear had been done during a postpartum visit at the age of 35 years. Her friend had recently encouraged her to resume cervical cancer screening. Mrs Lee said that she had reached menopause two years ago and did not have any postcoital or postmenopausal bleeding. [ABSTRACT FROM AUTHOR]

Cervical cancer is preventable, yet it remains the fourth most common cancer in women globally. The highest incidence and mortality occur in low- and middle-income countries (LMICs), where over 70% of women have never been screened, and 58% of the cases are in Asia. While the COVID-19 pandemic caused significant disruptions to cervical screening programs, particularly for LMICs, there were opportunities that emerged from the pandemic that were enablers of program recovery. Stakeholders played key roles in materialising strategy into implementation. Therefore, in this study, we examined the barriers and facilitators to implementing recovery strategies from the stakeholders' perspectives. We interviewed fifteen stakeholders from nine LMICs in the Asia-Pacific region directly involved in the implementation of the cervical screening program. A total of 23 barriers and 21 facilitators were identified, of which seven barriers and nine facilitators related directly to the pandemic. Pandemic-related barriers included movement restrictions, resource diversion, cancelled campaigns and training, deprioritisation of HPV prevention efforts, and a reduced health workforce. Stakeholders concurred that most barriers had predated the pandemic and remained as the pandemic eased. Conversely, the pandemic introduced facilitators such as means for targeted campaigns, improved understanding of viruses, accessible training with online platforms, better PCR testing capabilities, a shift in the government's position towards preventive health services, and openness to HPV testing and self-swabs. The emerging facilitators offered opportunities to address some of the persistent barriers, such as limited cervical cancer awareness and insufficient healthcare providers in screening programs. However, effective implementation of these emerging facilitators requires improved communication and collaboration between policymakers and implementers to accelerate the recovery of screening programs in LMICs. Further work is necessary to align emerging facilitators with the health system goals and resource settings of each country in turning these opportunities into actions., Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: SMG is supported by NHMRC APP1197951 Leadership Investigator grant level 3, a member of the advisory board for the nine-valent HPV vaccine of Merck, received an educational grant from Merck for study on HPV and young women through her institution and received Merck lecture fees. SK has served on advisory boards of both Merck & GSK and has received Merck and Roche lecture fees. IIP has received Roche and MSD lecture fees. DAM has received grants from Seqirus, non-financial support and honoraria from MSD, and non-financial support from Roche Diagnostics, not related to this manuscript. LJ has received honorarium from Abbott., (Copyright: © 2024 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)